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Background: The leading cause of maternal mortality in world is obstetric haemorrhage. Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract after 28weeks of pregnancy and before delivery of the baby. The aim of the present study is to study the demographic profile, type of antepartum haemorrhage (APH), maternal and perinatal complications in cases of APH and to formulate preventive guidelines so as to reduce maternal and perinatal complications in cases of APH.Methods: The study was a retrospective observational study conducted in Mahatma Gandhi Medical College & Research Institute, Pondicherry from November 2013- October 2016 [3 years]. Cases of pregnancy complicated with APH were taken. Cases with bleeding before 28 weeks and after delivery of the baby were excluded. Data collected from the records present in Labour ward complex and Medical record section.  Statistical analysis done by using SPSS software version 21.Results: Total 218 cases were presented with APH and the incidence was 2.9%. Among these 49.5% were Placenta Praevia, 42.2% were abruption placentae, 6.8% cases were indeterminate (3 cases of vasa praevia and 12 cases of excessive show) and 1.5% cases were of extraplacental cause(Local causes). Most cases were multipara with most common age group was 26-30 years (42.2%). Pregnancy in most of the cases was terminated during 34-36+6 weeks of gestation (73.0%). Most common associated risk factors found were previous caesarean section, preeclampsia, previous history of curettage, malpresentation and anaemia. Postpartum haemorrhage was found in 42.2% cases while in 4 cases peripartum hysterectomy done. Most common perinatal complications were due to low birth weight (66.5%).Conclusions: The morbidity and mortality in pregnancies complicated with APH can be achieved by early diagnosis, proper antenatal planning and terminating the pregnancy in a well-equipped tertiary health care centre.

A 28-year-old P 1 L 1 woman presented to our outpatient department with the complaints of mass descending per vaginum and foul smelling vaginal discharge for the past six months. She had an institutional normal vaginal delivery two and a half years back which was uneventful. She had history of irregular and excessive menstrual flow with intermittent abdominal pain for the last one year and was treated in local hospital medically.General examination revealed pallor and haemoglobin estimation was reported as 7.4gm/dl. There was no other systemic abnormality. Gynaecological examination revealed a mass protruding through the vaginal introitus which was globular and the broadest leading part measured 25x10x6cm [Table/ Fig-1]. The surface of the mass appeared hemorrhagic, edematous and had a shaggy look. No opening could be seen in the leading part of mass. Cervical os could not be identified. There was no active bleeding at that time. On palpation the mass felt firm and bled on touch. Vagina was completely inverted out, cervix could not be felt and the mass was found to be irreducible. Uterine sound could not be passed.Uterus could not be felt and a vacuum was felt anteriorly in the per rectal examination. obstetrics and Gynaecology SectionTransabdominal ultrasound could not identify uterus in its normal position in pelvis. A provisional diagnosis of chronic uterine inversion with submucosal fundal myoma was made and the patient was prepared for surgery. Continuous bladder drainage with Foleys catheter and broad spectrum intravenous antibiotics was started. Blood transfusion was done to improve her anaemic status preoperatively. Local dressing using the antiseptic solution of povidone iodine and hygroscopic action of magnesium sulphate was done daily. Intravenous pyelography was done preoperatively to trace the course of ureter. As the patient was young and desirous of future pregnancy, a combined abdomino-vaginal approach using Kustner's method was undertaken to reposition the uterus into the pelvic cavity. Vaginal myomectomy [Table/ Fig-2] was done by giving a longitudinal incision on the most dependent part of mass with posterior extension followed by enucleation of the fibroid. Redundant wall was excised and the uterus was reposed into the pelvic cavity [Table/ Fig-3]. Abdominal part of the operation entailed accessing the abdominal cavity through a transverse incision which revealed normal appearing bilateral ovaries, visible distal parts of fallopian tube and an absent uterine corpus along with the medial ends of fallopian tube. Through the abdominal approach, the uterine Non Puerperal Uterine Inversion in A Young Female-A Case Report aBstRaCt We report a case of 28-year-old, primipara who presented with complaints of mass descending per vaginum along with excessive bleeding and foul smelling vaginal discharge for the past six months. Clinical examination revealed an inverted uterus, cervix and vagina with a large submucosal fundal fibroid. A diagnosis of non-puerperal uterine inversion was made. Surgical manag...

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